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The preparation for phaeochromocytoma surgery is a matter of debate. Pre-operative blockade of α-1 receptors is increasingly employed in an attempt to reduce the risk of hypertensive episodes, especially during manipulation of the tumour. In this study, we compared the interest of an almost complete blockade of these receptors by high doses of urapidil in comparison with that of moderate doses of this drug. The study was conducted in two consecutive series of 18 patients, the first treated by a moderate dose, and the second by the highest dose tolerated by the patient. The two groups were comparable in other respects. All patients were operated under laparoscopy by the same surgeon and managed by the same anaesthetist using the same protocol. The number of hypertensive peaks was significantly reduced using the high dose of urapidil, with no more hypotensive episodes after tumour removal in this group. The area under the curve of norepinephrine levels as a function of time was significantly larger with the high doses of urapidil, arguing in favour of a more complete blockade of α-1 receptors. Our findings indicate the value of aggressive blockade of α-1 receptors in preparation for surgery of phaeochromocytoma.Journal of Human Hypertension (2009) 23, 605–609; doi:10.1038/jhh.2008.172; published online 19 February 2009 [ABSTRACT FROM AUTHOR]

The author analyzes the future of Eplerenone, an antihypertension drug, in Europe. Presently, the medical profession is looking forward to this new inhibitor of aldosterone receptor owing to its significantlyless adverse effects. Though, the drug is available in Europe, the cost factor of the drug and the lack of any proven efficacy in comparison to that of spironolactone will determine the future of the drug.

Objectives: It has been suggested that hypertensives at high risk of cardiovascular complications can be identified on the basis of their left ventricular mass as determined echographically. However, there is as yet a lack of consensus on the mode of indexation (body surface area, height, height[SUP2.7]) of left ventricular mass (LVM), and on the cut-off values for definition of left ventricular hypertrophy (LVH). The main objective of this study is to test the influence of the different modes of indexation for LVM on the prevalence of LVH in a population of never treated hypertensive patients on the basis of cut-offs for LVM based upon its relationship with ambulatory blood pressure (BP) measurement. Methods: A population of 363 untreated hypertensives was investigated using a standardised procedure. The men and women were analysed separately. We studied the relationship between mean daytime ambulatory systolic BP and LVM and calculated the LVM cut-off for a BP of 135 mm Hg using three different methods of indexation. On the basis of these criteria, the population was divided into those with and those without LVH. Results: The prevalence of LVH was found to be higher when LVM was indexed to height[SUP2.7] (50.4%) or height (50.1%). Prevalence was lowest when LVM was indexed to body surface area (48.2%), which tended to minimise the hypertrophy in obese individuals. Only indexation by height[SUP2.7] fully compensates for relationships between height and ventricular mass in this population. Conclusions: Indexing LVM to height[SUP2.7] thus appeared to give a more sensitive estimate of LVH by eliminating the influence of growth. Cut-offs of 47 g/m[SUP2.7] in women and 53 g/m[SUP2.7] in men corresponded to a cardiovascular risk indicated by a daytime systolic BP ⩾135 mm Hg. [ABSTRACT FROM AUTHOR]